Provider Demographics
NPI:1134802945
Name:KIMMEL, ENOCH
Entity type:Individual
Prefix:
First Name:ENOCH
Middle Name:
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DAKOTA CT APT 1
Mailing Address - Street 2:
Mailing Address - City:MINOT AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58704-1402
Mailing Address - Country:US
Mailing Address - Phone:210-628-9691
Mailing Address - Fax:
Practice Address - Street 1:114 DAKOTA CT APT 1
Practice Address - Street 2:
Practice Address - City:MINOT AFB
Practice Address - State:ND
Practice Address - Zip Code:58704-1402
Practice Address - Country:US
Practice Address - Phone:210-628-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home